A prospective, single-arm, multicentre clinical evaluation of a new localisation technique using non-radioactive Magseeds for surgery of clinically occult breast lesions.

AIM: To evaluate the safety, usefulness, and outcome of Magseed localisation for surgery of non-palpable breast lesions in a non-experimental setting. MATERIALS AND METHODS: An audit was undertaken of a prospectively maintained database of patients who had undergone breast surgery under Magseed guidance in two high-volume institutions in the UK. Patients were selected for Magseed localisation depending on service convenience. Wire localisations were used in other patients in accordance with previous normal practice. One hundred and thirty-nine Magseed localisaton procedures were performed between September 2017 and March 2019. Data were collected on age, body mass index, size, bra cup size, weight of specimen, surgery, histology, re-excision rate, and time and mode of insertion of seeds. RESULTS: A total of 137 patients had Magseed localisation with a total of 139 seeds. Sixteen patients had a diagnostic procedure and 121 had therapeutic surgery. The distribution of procedures were similar between the two institutes (n=63 and n=74). Mean age was 60 (range 28-81) years. The majority of seeds were placed under ultrasound guidance (n=112) and 25 lesions were targeted under stereo guidance. Mean size of the lesions was 15.2 (range 1-85) mm. The mean weight of the specimen was 75.5 (range 2-1,900) g. The mean body mass index was 30.56 (range 18.1-48.3). All Magseeds and index lesions were retrieved. The re-excision rate for patients who underwent therapeutic surgery was 14.8% (n=18). CONCLUSION: The Magseed localisation technique of non-palpable breast lesions is a safe, easy procedure, and comes with the advantage of better utilisation of theatre and radiology resources. The re-excision rate in this series is lower than the national average.

Axillary tumour burden in women with one abnormal node on ultrasound compared to women with multiple abnormal nodes.

AIM: To determine if the number of abnormal nodes seen on preoperative axillary ultrasound (AUS) is a predictor of the number of positive nodes at histology for women with needle-biopsy-proven positive nodes. MATERIALS AND METHODS: This prospective multicentre cohort study included consecutive patients with early breast cancer who had needle-biopsy-proven positive nodes on AUS and underwent axillary lymph node dissection (ALND) between October 2015 and July 2016. The number of abnormal nodes at preoperative AUS was recorded by breast radiologists or radiographers. RESULTS: One hundred and twenty-three patients were included in the study. The median age of the women was 62 (range 30-93) years. Fifty-four of the 123 (44%) women had one abnormal node, whereas 69 (56%) had multiple abnormal nodes on AUS. Forty of the 123 (33%) women had two or fewer nodes with metastases at histology after ALND. Tumours ≤20 mm (p<0.001) and one abnormal node on AUS (p<0.001) were associated with two or fewer nodes with metastases at ALND. Both remained significant in logistic regression analysis. The likelihood of at least three metastases based on the combination of these two factors had 95% sensitivity (79 of 83), 35% specificity (14 of 40), a negative predictive value of 78% (14 of 18), and a positive predictive value of 75% (79 of 105). CONCLUSION: Among women with needle-biopsy-proven positive nodes, around three in four women (78%) with an invasive tumour ≤2 cm and one abnormal node on AUS have two or fewer positive nodes at ALND. These women are overtreated by upfront ALND and can be offered sentinel node biopsy (SNB).

Traffic-generated noise pollution: exposure of road users and populations in Metropolitan Kuwait.

This study was carried out in metropolitan Kuwait with a sound level meter to assess peak hour and off-peak hour noise level. In local/collector streets, noise ranged between 56.0 to 79.2 dBA and 55.3 to 76.4 dBA; in arterial streets, 62.3 to 89.2 dBA and 59.6 to 78.9 dBA; and in freeways, 66.7 to 94.8 dBA and 64.9 to 89.1 dBA during peak and off-peak hour respectively. Values were higher than their prescribed standards which may pose a significant impact on quality of life. Findings of this research have shown that the level of traffic-generated noise pollution in Kuwait urban area is high enough to adversely affect the human health and well-being of its residents. Over 1,400 subjects responded to a randomly administered survey that assessed the physical health, personal well-being, and mental health. People residing in neighborhoods exposed to higher noise levels have significantly higher stress and noise annoyance levels and also adversely affected their sense of well-being. In the responder analysis, those people living in quiet neighborhoods had significantly higher mean scores in general health (35 points higher, p < 0.05), sense of vitality (30 points higher, p < 0.05), and mental health (20 points higher, p < 0.05) when compared to the other group. In addition, the component scores of stress and noise sensitivity for the participants living in quiet neighborhoods had significantly lower values (30 points lower and 59 points lower, respectively) than that of the participants living in noisy neighborhood. With the rapid expansion of the infrastructures in metropolitan Kuwait, it is virtually definite that traffic noise will shortly assume a dangerous dimension, and will be a ground of escalating fear for both the public and liable policy-makers. The quality of life in metropolitan Kuwait will certainly be negatively affected.

Influence of imaging on touch imprint cytology of breast lesions.

PURPOSE: Touch imprint cytology (TIC) facilitates rapid diagnosis of breast diseases in women attending triple assessment clinics. Some pathologists, in our centre, feel that pathological interpretation of TIC slides is contentious when the lesions are radiologically indeterminate (R3), as these can lead to potentially higher false positive or false negative cytology results. We hypothesised that: '(R3) lesions are more likely to have higher false positive or false negative TIC and/or be inadequate for TIC assessment'. In other words, 'imaging influences cytological classification especially when indeterminate'. METHODS: Review of the data collected in our centre between December 2003 and July 2005. All patients who attended the one stop symptomatic breast clinic and had a TIC performed following an ultrasound (US) guided core biopsy (CB) were included. Demographic, radiological, cytological and core biopsy grading data were collected. Cytology grading was correlated with radiology classification to assess our hypothesis. RESULTS: A total of 248 patients underwent 254 CB/TIC. The average patient's age of the group was 54 years (range of 29-95). On TIC, 186 (73%) were deemed malignant, 23(9%) benign while 33(13%) were inadequate for assessment. There was no false positive or false negative TIC. There was good correlation between TIC and CB results (p<0.0001). Thirty-three cases were inadequate (C1) for cytology assessment, of these 16 (48.5%) were indeterminate on imaging. R3 lesions were 6 times more prone to have C1 cytology (p<0.0001). CONCLUSION: Touch imprint cytology is a reliable and efficient method in running a one stop breast clinic, with the backup of full tissue diagnosis. Careful selection of cases that would benefit from this technique is highly recommended as a significant number of radiologically indeterminate lesions are likely to be insufficient for cytological assessment. Further prospective trials are required to assess this further. Until then the diagnosis in this sub-group should depend on core biopsy.

Axillary lump: an unusual presentation of fat necrosis in the breast.

The clinical presentation of an axillary lump, in majority of cases, raises suspicion of an enlarged lymph node due to malignant causes. In this case report, we established a diagnosis of an axillary lump caused by fat necrosis. We present this case report with review of the literature to familiarize clinicians with this condition.

The impact of image guided needle biopsy on the outcome of mammographically detected indeterminate microcalcification.

A study was carried out to examine the impact of development in image guided needle biopsy on the outcome of mammographically detected indeterminate microcalcification. Between 01.04.1991 and 31.03.2001, the South East London Breast Screening Programme detected 392 cases of indeterminate microcalcificaton. Histological diagnosis was obtained using open biopsy, fine needle aspiration cytology (FNAC), 18/14 G wide bore needle core biopsy (WBNCB) and 11 G vacuum assisted core biopsy (VACB). The study period group was divided into two. Group A (between 01.04.1991 and 31.03.1996) and group B (between 01.04.1996 and 31.03.2001). There was a significant reduction in the benign open biopsy rate in group B compared to group A (25% vs. 51%) (P=0.0001). Of the malignant cases, there is a higher percentage of ductal carcinoma in situ (DCIS) in group B compared to group A (77% vs. 62%). In conclusion, the implementation of more effective methods of image guided biopsy has led to a 50% reduction in benign open biopsies for indeterminate microcalcification and to an increase in the detection of DCIS.

Focal nodular hyperplasia in a child with hemihypertrophy and multiple cutaneous vascular malformations.

A case of focal nodular hyperplasia of the liver occurring in a 9-year-old girl with musculoskeletal hemihypertrophy and multiple cutaneous capillary haemangiomata is described. The child presented because of limb length discrepancy and was found to have a large mass in the liver. Imaging showed a mass of similar characteristics to normal liver tissue. Prominent vascular supply to the liver was also seen. We present this case to emphasize the important diagnosis of focal nodular hyperplasia, which may occur in syndromic form in children with typical cutaneous and skeletal manifestations.

Dialysis centers in the kingdom of saudi arabia.

To help future planning of the dialysis services in the different geographical regions and health sectors in Saudi Arabia, we surveyed its 130 active hemodialysis (HD) centers using a questionnaire about their manpower, hemodialysis equipment, as well as, peritoneal dialysis and transplant patients at the end of the year 2000. Almost all the dialysis centers were on hospital campus but of variable sizes with an average ratio of 14.8 dialysis machines per center (range 2-113 machines per center). The distribution of the dialysis centers according to the geographical regions of Saudi Arabia included 18(14%) in the northern, 25(19%) in the southern, 13(10%) in the eastern, 35(27%) in the western and 39(30%) in the central region. There was a total of 6,694 dialysis patients served on 1,918 hemodialysis machines. There were 1,793(93%) HD machines capable of performing bicarbonate dialysis. There was an average ratio of 3.5 patients per one HD machine. In addition to the hemodialysis, there were 28(22%) centers engaged in peritoneal dialysis (PD) and 56(43%) centers in the follow-up of post transplant patients. The total number of the nephrologists, regardless of their expertise was 212 of whom 180(84%) spoke Arabic; the average ratio was 32 patients per nephrologist (range of 14-58). There were 1320 hemodialysis nurses of whom only 465(35%) spoke Arabic. The average ratio of patients to nurses was five patients per nurse (range of 4-6). There were 72(55%) social workers and 70(54%)dietitians with average patients ratios to these supporting services of 1:93 patients (range of 1:58-137) and 1:96 patients (range of 1:53-137), respectively. The study HD patients had a mean age of 47.8 +/- 17.1 years (range: 2-92 years); of them, 52.5% were males and 12% had non-Saudi nationality. Of the hemodialysis patients, 1,815(27%) were diabetics. The calculated net increase of dialysis population was 988 patients per year (14.8%). There were 5,700(85%) patients on regular bicarbonate dialysate. Chronic viral infection were noted in more than half of all the dialysis population: thus 3,380(50%) were positive for hepatitis C viral (HCV) serology, 448(7%) had positive hepatitis B (HBV) antigenemia and six(0.1%) had the human acquired immunodeficiency syndrome. In conclusion, our findings demonstrated a satisfactory advancement achieved in many Saudi dialysis centers in terms of equipment, personnel and patients' care. However, there should be more emphasis in the future on quality care through better self-assessment of the performance of these centers.

Morphological and anatomical studies on larval trematode of genus Brachylaima (Brachylaimidae) from the land snail, Monacha obstructa.

The metacercariae of genus Brachylaima were collected from the kidney of the land snail Monacha obstructa. About thirteen to fifteen metacercariae were collected from each snail. The metacercariae observed were elongated rather than oval. The gonads were no so developed inspite of the great similarity between this larval stage and the adults. No larval stages rather than the metacercariae were observed. The specimens were examined in fresh status and then stained with carmine and fast green as counter stain. The excretory system was developed to very great extent. This seems to be the first record of this larval stage in Egypt since 1899 when Looss collected the adult of B. aequans from Gerbillus aegyptiacus. The heavy infection of snails reflects the higher incidence of this parasite among land snails as intermediate host. Since, the life cycle of this parasite is not yet confirmed experimentally in Egypt, the species has not been identified.

Assessment of the histopathological lesions and chemical analysis of feral cats to the smoke from the Kuwait oil fires.

Twenty-six adult or subadult feral cats were collected from Kuwait approximately 8 months after the ignition of the Kuwait oil wells. These animals were obtained from two sources: 12 animals from Kuwait City, a relatively smoke-free area, and 14 from the city of Ahmadi, an area with heavy smoke. Animals were euthanized and a complete set of tissues consisting of all major organs was taken for histopathology. Samples of lung, liver, kidney, urine, and blood were also taken for toxicology. Histopathological lesions observed in the lung were mild accumulations of anthracotic pigment in the lungs of 17 cats. Hyperplasia of the bronchial and bronchiolar gland in 8 cats, and smooth muscle hyperplasia of bronchioles in 14 cats. Tracheal gland hyperplasia was observed in 7 cats, and minimal squamous metaplasia of the tracheal mucosa in 17 cats, Laryngeal lesions consisted of submucosal gland hyperplasia in 2 cats and squamous metaplasia of the mucosa in 5 cats. Hyperplasia of the nasal submucosal glands was observed in 6 animals. The pharyngeal mucosa as well as other organs and organ systems were normal in all cats. Atomic absorption analysis for 11 metals was performed; vanadium and nickel levels (two metals that were present in the smoke from the oil fires) are not indicative of substantial exposure to the oil fires. Based on the histopathological findings and toxicological analysis, it is felt that inhalation of air contaminated with smoke from the oil fires had little or no long-term effect on the animals examined.

Transport of Eimeria necatrix sporozoites in the chicken: effects of irritants injected intraperitoneally.

Light and electron microscopic observations confirmed that Eimeria necatrix sporozoites first enter villous epithelial cells of the chicken small intestine and are transported to the crypts by mononuclear cells. Ultrastructurally, these cells resemble granulated intraepithelial lymphocytes (IEL) rather than macrophages, as suggested previously. The injection of chickens intraperitoneally (i.p.) with a variety of irritants, including proteose peptone, at the time of oocyst inoculation or up to 12 hr postinoculation (PI) resulted in a delay in the arrival of sporozoites at the crypt. Significantly fewer sporozoites had arrived at the crypt by 24 hr PI in i.p.-injected birds as compared to controls. This delay in the arrival of sporozoites at the crypts was reflected by a delay in the development of intestinal lesions and in peak oocyst production. However, there was no significant decrease in the total numbers of oocysts produced by these birds as compared to controls, indicating that no significant loss of sporozoites occurs during the possible rerouting of the parasites. The presence of infective stages in extraintestinal sites was detected by transferring various tissues to coccidia-free recipients. Infection was transferable by gut, liver, and spleen from irritant-injected and control birds at all time intervals studied (12, 24, 36, and 48 hr PI). Infection was also transferable with blood and kidney, but not consistently. A small number of oocysts was passed by the recipients of peritoneal wash from irritant-injected birds at 12 hr PI. In all transfers, the prepatent period was normal, suggesting that the migrant stages are sporozoites.

Invasion of chicken caecal and intestinal lamina propria by crypt epithelial cells infected with coccidia.

The development of second generation schizonts of Eimeria necatrix and E. tenella was studied with the electron microscope. Invasion of the crypt epithelial cells by merozoites of the first generation schizonts caused changes in the morphology of the infected cells and stimulated their migration into the lamina propria through breaks which appeared in the basement membrane of the crypts. Second generation schizonts developed in the lamina propria within these crypt cells whose epithelial origin was confirmed by their interconnection by desmosomes and tight junctions and by their possession of characteristic microvilli. A comparison is made between this invasion of the lamina propria by parasitized cells and invasion of connective tissue by malignant epithelial cells; the possible mechanisms involved are discussed.

The application of the soluble antigen fluorescent antibody test for the diagnosis of avian influenza.

The application of the soluble antigen fluorescent test as a tool for serological investigation of influenza type A infection in wild birds was studied. The soluble antigen fluorescent antibody test is basically an indirect fluorescent antibody test except that an artificial matrix of cellulose acetate discs is used as a substrate for antigen and the test results are scanned and recorded by a fluorometer. THe influenza type A soluble antigen fluorescent antibody was obtained from concentrated and detergent disrupted virus particles, absorbed onto cellulose acetate discs. Anti-influenza sera were prepared in pheasants and ducks to A/turkey/Ontario/6118/67 and in pigeons to A/turkey/Ontario/6213/68. The antigen-antibody complex was detected by specific staining with monovalent or polyvalent fluorescein isothiocyanate conjugated rabbit anti-avian immunoglobulins. The soluble antigen fluorescent antibody test is a sensitive technique for the detection of specific influenza A antibodies in several avian species, and could be adapted for use in large scale surveys.